vertigo dr. anwar

8/12/2019 Vertigo Dr. Anwar

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Vertigo

Vertigo

anwar wardy w dept.neurosain fkk umj


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Steps1.History Taking

2.Clear definition(Vertiginous or Nonvertiginousdizziness)

3.Peripheral or Central Vertigo4.Psychogenic Vertigo



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Differential diagnosis1.Dizziness

2.Presyncope3.Disequilibrium:Unsteadygait

4.Light-headedness



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Symptoms Unconscious Pallor Sweating

Nausea/Vomiting Auditory Symptoms :Hearing loss, Tinnitus, aural

(ear) fullness Diplacusis Paracusis Neurologic Symptoms: numbness, weakness,

difficulty with swallowing or speech



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Definitiona subjective sensation ofmovement

May feel either that himinvolving in space or thatobjects in the environmentare moving around him.



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History Taking Description of the sensation (including

associated symptoms) Onset (acute, gradual) Duration (date sensation was first noted,

length of time it lasts) Intensity (how troubling is it?)

Exacerbations (activities, positions,circumstances that worsen situation)



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Remissions (activities, positionscircumstances that make sensation better)

Medications (prescription, herbal, over thecounter)

Other medical problems (diabetes,hypertension, heart disease, etc)

Psychosocial (any stressors?)



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Physical Examinations

Mental conditions

Vital Signs: Bp,HR

Otoscopy Ascultation of the neck for bruits

Rinne Test

Webers Test



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Rinne Test



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Neurologic exams

Nystagmus Rombergs

Gait

Dix-Hallpike Maneuver



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Dix-Hallpike Maneuver



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Peripheral Vertigovs

Central VertigoFeatures Peripheral

VertigoCentralVertigo

Conscious Conscious Unconscious

Nystagmus Horizontal/rotary Vertical

Related to positionchanging

Yes No

Symptoms Auditory symptoms

(auralfullness,tinnitus,hearing loss)

Neurologic

symptoms(disequilibrium,gait)



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Comparison of Common Diseases

Features BPPV Meniere(Labyrinthitis)

Psychogenic CentralVertigo

Type of Vertigo Positional Spontaneous Variable Variable

Duration ofVertigo

1-2min 30min-2hrs Several years Several days-months

Symptoms Auditory symptoms (aural

fullness,tinnitus ,hearingloss)

Palpitations,hyperventilati

on

Neurologic symptoms

(Disequilibrium,unconscious)

Nystagmus Horizontal/rotary Horizontal/rotary Horizontal Vertical

Dix-hallpikemaneuver

+ -/+ - -

Neurologic exam(Rombergs sign)

- - - +

Treatment Repositioning Maneuver 1.Salt-restricted diets2.Diuretics

3.Vestibular suppressants(Meclizine)

4.Surgical;Gentamycininfusion into the middleear

Anti-anxiety or Anti depression drugs

Furtherexaminations(MRI,CT)



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Peripheral Vertigo

Benign paroxysmal positional vertigo: mostcommon in adults

Acute Labyrinthitis Chronic Labyrinthitis (Menieres

Syndrome) Toxic Labyrinthitis Vestibular Neuronitis

Acoustic Nerve Lesions Labyrinthine Ischemia



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Central vertigo Brainstem Lesions

Intravascular: Vertebrobasilar

insufficiency Tumors

Intracranial infection

Demyelinating diseases: MultipleSclerosis, Syringobulbia()



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Conclusions1.History Taking2.Physical Examinations

3.Psychogenic Vertigo must be consider4.Labs for necessary



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Weber

s Test


vertigo dr. anwar

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